Special Medical Reports

AAP Releases Recommendations on Use of Inactivated and Live Oral Polio Vaccines

SHARON SCOTT MOREY

Am Fam Physician. 1999 Jun 1;59(11):3268.

The American Academy of Pediatrics (AAP) Committee on Infectious Diseases has released the complete AAP recommendations for the use of inactivated poliovirus vaccine (IPV) and live oral poliovirus vaccine (OPV). The recommendations are published in the January 1999 issue of Pediatrics. The recommendations state that AAP anticipates that by the year 2001 only IPV immunization will be recommended for children in the United States.

“Special Medical Reports” in the January 1, 1999, issue of American Family Physician contains the 1999 childhood immunization schedule (see page 203). As reported in AFP, one change in the immunization schedule is the recommendation that IPV be administered for the first two doses, at ages two months and four months. The immunization schedule is the product of a collaboration among the Advisory Committee on Immunization Practices, the American Academy of Family Physicians and the AAP.

The following summarizes the AAP recommendations for use of IPV and OPV:

For the first two doses of poliovirus vaccine, IPV is recommended under most circumstances for all children at ages two months and four months. OPV immunization is acceptable when the parents refuse IPV or object to the number of injections needed to administer all of the other recommended vaccines.

Depending on whether a sequential or an IPV-only regimen is used, the next two doses of OPV or IPV should be given at six to 18 months of age and at four to six years of age. If OPV is given for the third and fourth doses, some experts recommend delaying the third dose until the child is 12 months of age.

An IPV-only regimen is recommended for immunocompromised persons and their household contacts (OPV is contraindicated in these persons). Because of the increased risk of vaccine-associated paralytic poliomyelitis, it is also recommended for infants and children in households with persons older than 17 years of age who are known to be inadequately vaccinated against poliomyelitis.

An OPV-only regimen is acceptable when the routine immunization schedule was not instituted until after six months of age or if an accelerated schedule is necessary.

For children who will be traveling to areas where wild-type poliovirus is endemic, selection of the type of vaccine depends on the interval until departure and the number of doses that have already been administered. Two doses of IPV at a minimal interval of one month are recommended for previously unimmunized children who will be traveling in two months or more. If travel will be in less than two months in a previously unimmunized child, a single dose of either OPV or IPV should be given and the immunization schedule should be continued after arrival in the foreign country. If a child has received two doses of IPV, administration of two doses of OPV at an interval of at least one month apart will provide optimal immunity.

If an outbreak of wild-type poliovirus infection occurs in the United States, OPV is the vaccine of choice to control the spread of infection.

The AAP recommendations note that data from the Centers for Disease Control and Prevention show an increase in the use of IPV. In 1997, IPV accounted for 29 percent of all poliovirus vaccine doses; in 1996, it accounted for 6 percent.